The Chronicle series on homelessness ("Shame of the City," Nov. 30- Dec. 4) forcefully and effectively reported how homeless people live and die on the streets of San Francisco. But the individual portraits are just the tip of the iceberg.

The series underestimated the extent of mental illness among the city's homeless population. Unlike some of the authors' portraits, the vast majority of mentally ill people are not choosing to be homeless, nor are they stubbornly resisting help. The cold fact is that there is very little help available. People with serious mental illness are particularly vulnerable to becoming homeless. Debilitating symptoms, lack of social supports, ostracism from society and extreme poverty underlie this vulnerability.

Notwithstanding their symptoms, many people with mental illness refuse to take medications, often because they cannot tolerate the frequent and disturbing physical and psychological side effects of many antipsychotic medications. Yet, for many, medication permits them to cope with their illness, particularly when combined with adequate care and support.

Choosing to forgo medication, many people turn to alcohol or illicit drugs in a misguided and desperate attempt to treat themselves, to feel subjectively better, even though this often fundamentally aggravates their illness. The tragedy is that these illnesses are expensive in financial and human terms when untreated and often lead to dangerous and sometimes fatal consequences.

As The Chronicle series noted, successful experiments in several cities including San Francisco have convincingly demonstrated that homeless people with mental illness can be helped with a combination of targeted services. The crucial ingredients include:

-- diagnosis and treatment of their symptoms and substance abuse;

-- a specialized kind of "education" that helps them improve their abilities to live in the world and in some cases to work;

-- supportive housing and a range of social services; and

-- a long-term intensive relationship with trained personnel who are committed and able to trade on the trust they develop with their patients to persuade them to take medication.

While all governments -- and even businesses -- share the responsibility for dealing with the problem, the blame must be placed mostly on the federal government. Washington collects the largest share of taxes and has the greatest flexibility in the use of this money. Yet it has never seriously addressed the issue, preferring to leave the states and cities to struggle on their own. Moreover, it has eliminated much of the funds that it did provide in the past.

The federal government several years ago eliminated Supplemental Security Income, Medicaid and Medicare for those people with primary substance-abuse disorders, sometimes without regard for an underlying mental illness. Even if it can be argued that substance abusers misuse SSI money to purchase illicit drugs, this does not justify the elimination of federally funded medical assistance. Without federal support, cities are ill-equipped to treat substance abuse among the mentally ill homeless.

The availability of federal support for methadone programs, for instance, is extremely limited. In San Francisco, according to Health Department estimates, there is only enough to treat 2,500 of the 15,000 people addicted to heroin, with and without mental illness.

The regulations of Medicaid and private health insurance have become so draconian that hospitals are often forced to discharge mentally ill patients before after-care services and housing can be arranged. Instead, temporary shelters have become an acceptable discharge option. While the safety of these shelters is arguable, no one could reasonably contend that they are anything more than way stations to the streets.

The growing prevalence of homelessness has a well-known history. Fifty years ago, states began discharging mentally ill patients from their hospitals, partially in order to save money and partially because many mental health professionals, lawyers and advocates believed that sterile and underfunded state hospitals were so antithetical to treatment and rehabilitation that almost any other environment was better. At the outset of this movement, it wasn't recognized just how much help these patients would need to survive in society. People at all levels of government simply turned their heads the other way and many patients ended up on the streets and in jails in an inverse ratio as hospital beds declined. Jails now have more mentally ill patients than state hospitals. It goes without saying that the availability of treatment in most jails is virtually nonexistent.

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In certain respects, legislation enacted in California may have complicated the problem. The Lanterman-Petris-Short Act of 1967 made it more difficult to commit patients to hospitals against their will by setting a high (in our view, reasonable) standard requiring as a condition of commitment that the patient be demonstrably dangerous to him or herself or others, or alternatively be shown to be gravely disabled to the extent of being unable to provide for his or her own physical safety.

The problem was that judges or hearing officers empowered to make these difficult decisions were frequently untrained. Equally problematic, the law did not require that evidence of the historical course of the person's illness be considered or that information provided by family be taken into account. Many patients who badly needed treatment and who would have been found to meet the standard of commitment were either not admitted to hospitals or were prematurely discharged because the relevant history, often known best by their families, was not considered.

Compounding families' frustration was that many of their mentally ill relatives were as a result discharged back into their care. Into the streets these patients slipped again when they either rapidly deteriorated or exhausted the resources or patience of their families.

In recent years, through the persistent efforts of Assemblywoman Helen Thomson, D-Davis, this law was amended. Courts are now required to take into account the historical course of the patient's illness and any information relevant to this provided by the patient's family. Thomson also pushed through legislation encouraging counties to establish mental health courts, giving mentally ill patients who had committed minor crimes the option of involuntary commitment on an outpatient basis as an alternative to jail.

In San Francisco, Mayor Gavin Newsom has taken on homelessness as his highest priority. In a tough budget period, this takes real courage, particularly because he is sophisticated enough to know what he is taking on and to recognize that it cannot be solved cheaply. Obviously, the mayor cannot do this without the support of the Board of Supervisors and without mobilizing virtually all segments of San Francisco society. Whether his Care Not Cash proposal is the solution is less important than the fact that he is determined to come up with some solution. The $150 million housing bond issue he has proposed, if passed by the voters, would be a giant first step.

It is crucial to remember that governments are not some outside force: They are us. In ignoring the problems of homeless people, they are responding to the majority of the nation's citizens, who want the problem simply to disappear without having to pay for it. Citizens have demonstrated more willingness to spend their money on guns than on solving the problem of homelessness. When the cost of the Iraq war is considered, it is obvious that the problem is not a lack of money but of political will. When the people decide to tackle the problem of homelessness, it will be solved.